health systems, monitoring, evaluation, learning.

Rethinking the use of the word ‘simple’ in global health solutions

Karen had a nice post this week about how we talk about ‘simple’ solutions to global health problems, here.

There are at least four reasons that we might apply the word simple when we are talking about global health solution concepts:

1. The concept is relatively obvious because it relates to basic aspects of life, such as eating and drinking, and/or has been known for a long time

2. The concept has relatively few moving parts (i.e. does not call to mind Rube Goldberg-like steps (or that game mousetrap that NEVER worked))

3. The concept is low-tech (both information and biomedical technologies)

4. The concept is an easy change to get people to adopt

I suspect that when people refer to ‘simple’ solutions, it is some combination of 1, 2, & 3 on the list. If ‘basic’ or ‘low-tech’ is what we mean, we should probably say it as such. ‘Simple‘ has a wide variety of interpretations, so when you hear it, it may not always mean what you think it means or others may misinterpret your intention. Also, even if a concept has few moving parts, if the surrounding health system and infrastructure are thin, over-burdened, or non-existent, it can be quite tough to implement.

Basic and low-tech solutions have been put forward as part of the primary health care and then the selective primary health care (and GOBI-FFF) movements, spanning roughly the last 50-60 years. Calls for improvements in vital registration systems and disease surveillance span a similar time period. The fact that we are still talking about them suggests the solutions are not ‘simple’ (as in, ‘easy’) and that we need to be a lot smarter when it comes to changing behavior (giving up an old behavior *and* adopting a new one). This requires not only making the new behavior appealing and the old one unappealing but building an entire supportive and enabling environment around it. And as Karen rightly points out, even in what should be highly supportive environments, basic ideas can still be tough to implement on an individual level.

From a branding perspective, ‘basic’ and ‘low-tech’ may not be enough to garner (donor) attention to ‘mundane’ causes of morbidity and mortality (malnutrition, diarrheal disease, & acute respiratory infections) and the preventative and curative measures needed to address these problems. But the gloss ‘simple’ is definitely insufficient and misleading.